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Why Genesis?
 
   
Genesis Fertility & Reproductive Medicine is one of many medical practices in the New York metropolitan area dedicated to the treatment of reproductive disorders. The stated mission of all of them is the alleviation of infertility. Still, they are not all alike. Some programs provide a limited scope of basic services, while some are focused mainly on the high-tech procedures. Some are based in hospitals, while others are free-standing, privately owned ventures. Some are large and impersonal, while others are small, boutique-type offices. Good care can be obtained in many of these facilities. The paragraphs that follow will describe just what sets GENESIS apart from other fertility practices - exceptional care and exceptional results.

THE ELEMENTS OF EXCEPTIONAL CARE
We deliver exceptional care by bringing together, under one roof, a talented and highly experienced team of individuals providing comprehensive services to couples with infertility.

Comprehensive services
Everything about the GENESIS practice reflects our dedication to serving the individual patient. Foremost is the comprehensiveness of what we provide. This includes not only the expert services of reproductive endocrinologists, but also care from other specialists that can be crucial to success. They include:
• A urologist specializing in male fertility, on site
• A psychologist with special expertise in counseling individuals and couples with infertility, on site
• A genetic counselor, with special training in counseling about genetic diseases and the fertility procedures used to
   overcome them, on site
• Reproductive scientists who are able and willing to discuss with patients the laboratory techniques they use for
   assisted conception, on site
• A certified Family Nurse Practioner, on site

These professionals are supported in their work at GENESIS by a nursing, clinical and administrative staff whose energies are exclusively focused on the alleviation of infertility.

Location and Physical Space
The main office of GENESIS is located in the quiet, residential neighborhood of Dyker Heights, Brooklyn. It is less than five minutes from the Verrazano Bridge and Belt Parkway, making it easily accessible not only to our Brooklyn patients but also to patients from the South Shore of Long Island, Staten Island and the New Jersey Coast. Parking is available right outside the building; this is an especially useful feature for those patients requiring frequent visits during a treatment cycle. Unlike patients who use practices located amidst the congestion of Manhattan, patients in treatment at GENESIS generally find that they are able to come and go without hassle and without having to lose time from work. GENESIS now operates satellite offices conveniently located in central Staten Island, Park Slope, Brooklyn and Hewlett, Long Island.

The GENESIS facility was specifically designed and built to house all of the elements necessary to deliver state-of-the-art fertility care. The colors and décor were chosen to foster a relaxed atmosphere. The reception area has the feel of a reading room. The consultation rooms are warm and inviting. Examination rooms are spacious, with private access to bathroom facilities. The operating suite and full laboratory facilities are located on another level, out of view of those not needing them. On the other hand, those patients requiring advanced care appreciate having these facilities on site. This keeps the total care of every patient in the hands of our dedicated staff. Patients at GENESIS have no need to come into contact with any hospital staff or any others who may not understand the ordeals of infertility.

As a way of providing an appropriate environment for patients struggling with infertility, we have chosen not to line our walls with the many pictures of babies. (We have, however, hung thousands thank-you notes on our walls; most patients generally appreciate and are encouraged by them.)  Successful patients are referred early to their obstetricians, so no active patient ever shares the reception area with a woman who is visibly pregnant. As a rule, we discourage all patients from bringing children to our office. (As much as we appreciate visits from former patients and their children, certain times are designated for such visits.)

Hours of operation
We have found that patients and staff alike prefer early morning to late afternoon or evening appointments. Consequently, our office opens to patients daily at 6:45AM. For patients in treatment cycles, daily monitoring can usually be completed within 15-20 minutes, leaving ample time to get to work. New patients and those wishing to schedule consultations also find the early hours very accommodating to their schedules.

Of course, the GENESIS practice is open 365 days a year, reflecting the needs of patients undergoing fertility therapy. Physicians, ancillary clinical staff and laboratory staff are available as needed to meet the needs of every patient requiring monitoring or treatment during weekends and holidays. Physicians are always on call for emergencies.

Support staff
Every staff member at GENESIS has been sensitized to the needs of individuals and couples with infertility. From the first contact to the last visit - usually, on the way to the obstetrician - patients at GENESIS will feel that every aspect of their care has been delivered by professionals who understand their needs and always have their best interest in mind. While we cannot guarantee the ultimate outcome of patient care, we do guarantee that every patient is treated with respect and compassion. In keeping with our mission statement, we always put Patients First.

Record keeping

Most medical offices use computers to keep track of billing issues. At GENESIS, we use computers to keep track of all clinical information on every patient. We believe that electronic recording all of all patient medical data is fundamental to patient safety. An electronic medical record is created for every new patient, linking all information about her with that of her spouse or significant other, as appropriate. The complete medical history, as well as the physical exam, physician assessment and treatment plans are all documented electronically.

The ready availability of charts on the computer network fosters immediate and thorough documentation. Information cannot be lost or misread, a crucial element in preventing medical errors. Additionally, the system eases the process by which all of us do our jobs, giving us more time to keep every patient psychically and emotionally comfortable during her treatment cycles. In a very real way, therefore, the electronic record is an essential ingredient behind the personalized attention that distinguishes care at GENESIS. (The best people, of course, being the major part.)

While some practices are just now integrating information technology into patient care, and most others still use paper charts, at GENESIS we have over a decade of experience in using electronic records successfully in the care of many thousands of patients. We are proud that our record of success is matched equally by our record of safety.

Patient Education

The physicians at GENESIS have been in practice for nearly two decades. Over time, they have developed an approach to patient education that is evident in every aspect of care. Essentially, an educated patient is our best patient. To that end, we take pride in explaining to our patients the rationale underlying our approach to treatment, as well as all the pertinent information that must be understood prior to commencing treatment. Additionally, we provide explanatory written handouts for virtually every step of treatment. Nearly all of these have been prepared by the physicians. Thus, they reflect the GENESIS philosophy and process.

When advanced reproductive technologies are planned, the nursing staff gives formal instruction covering all the procedures critical to proper patient care. Most patients coming from other practices are surprised at the level of detail that describes these presentations. At GENESIS, we take pride in having you understand not only what we do but also why we do things certain ways. Your knowledge of the processes we use assists us in delivering proper care and optimizing the outcome. Educated patients are our most successful patients, too.

Cost
A common misperception about fertility care is that it is not covered by insurance, prohibitively expensive and out of the reach of those who cannot afford large out of pocket payments. As a result, couples confronting the need for fertility therapy often anticipate that they will need to expend part or all of their life savings in order to pay for their care. Fortunately, these notions are untrue. Most couples at GENESIS are insured for fertility treatments, including IVF. Here's why:

Insurance companies generally have a preset reimbursement rate for procedures performed, which are described using common procedure terminology, or CPT codes. The ways in which these rates are determined vary by insurance company, but once they are set the companies do not waiver from them, regardless of what specialty the doctor practices, what training or expertise are involved, or what the quality is of the service delivered. Just a few years ago, CPT codes did not even exist for many of the treatments used in reproductive medicine. Because insurance companies were unprepared to deal with this specialty, most services were "uncovered." Patients had to pay for most of the treatments, even if their physician was a "participating provider" with their insurance company.

Thanks to the efforts of the American Society for Reproductive Medicine, CPT codes now exist for virtually every aspect of fertility care. Pressure from infertility advocacy groups such as RESOLVE and the American Fertility Association have convinced most large insurers that covering fertility care is proper, and in many states, New York included, nearly all insurance companies are required by law to cover the costs of fertility care. Still, most reproductive specialists have shied away from participating on the panels of insurance companies, leaving their patients to bear the costs of care. This minimizes their need to work with insurance companies and maximizes their reimbursement. On the other hand, it leaves most patients unable to afford their care.

At GENESIS, we believe in promoting access to care. To that end, we have worked long and hard with insurance company executives to arrange fair reimbursement rates for the services we render. As a result, our physicians are able to participate in most insurance plans, and most of our patients are therefore insured for their treatment. GENESIS is one of only five fertility practices in New York City that has been designated by the Empire Plan as a Center of Excellence.

Patients who require in vitro fertilization who are not insured can take advantage of a number of programs to assist them with financing their care. The most popular of these is run by New York State, and is called the Fertility Demonstration Project. GENESIS is one of seven centers in the state participating in the project, whereby patients who are New York State residents and whose insurance does not cover IVF are given a government grant to assist in paying for their care. The amount of the grant is proportional to their income. Our billing department has a long experience in managing the grant program and is fully able to counsel our patients to determine their eligibility and benefit level.

Patients requiring advanced reproductive services who are not insured and not eligible for the NYS Demonstration Project have other options to consider, including financing coverage and participating in money-back refund programs. For further information regarding these programs, please visit us on the web at www.genesisfertility.com or contact our billing office.

THE ELEMENTS OF EXCEPTIONAL OUTCOMES

In the business world, it is common to identify certain "benchmarks" that serve as measures of quality. Airlines use their on-time rate. Financial services use their rate of return. In medicine, the benchmarks that define quality can be much more difficult to define. What we've outlined above is what we believe are measures of quality, and by those measures we define the quality of care as exceptional. But there are also other benchmarks of high quality medical care; in the field of reproductive medicine one benchmark stands above all the rest - the delivery of a healthy baby.

What the numbers show
As a member program of the Society for Assisted Reproductive Technologies, or SART, we report pregnancy rates from the in vitro fertilization program at GENESIS on an annual basis. These rates are available on line at www.cdc.gov/reproductivehealth/ART03/index.htm or on our website, www.genesisfertility.com. Our pregnancy rates have for many years been at or better than the national average, and certainly competitive with the other programs in our area. To appreciate just how good our statistics are, however, it is helpful to understand just how to read the data from SART.

What the numbers do not show
There are several limitations to the SART statistics. Understanding those limitations goes a long way to explaining why the outcomes at GENESIS are a cut above the rest:

(A) SART has chosen to publish data from IVF cycles only. The database says nothing about what happens in any given practice to patients who are treated by methods other than IVF. Thus, patients who conceive using alternative, less aggressive interventions, are not represented in the statistics. To a certain extent, practices that use IVF more conservatively, saving it mainly for their most difficult cases, are penalized by the focus of the database on IVF pregnancies only. This is certainly the case at Genesis where, for financial and other reasons, most patients are able to turn to IVF only under the most extreme circumstances. That notwithstanding, our pregnancy rates from IVF remain robust.

(B) Patients entering fertility treatment generally would like to know their chances of conceiving using a particular treatment. While optimally they would prefer to conceive within one treatment attempt, most educated patients understand that assisted pregnancies, like natural ones, occur over time. Yet, the SART database is focused not on pregnancies per patient but rather on pregnancy rates per cycle. This focus has forced many reproductive specialists to do whatever it takes to maximize the chance of pregnancy during any given cycle, even if it means putting back more than an appropriate number of embryos. But inflating the pregnancy rates in this way comes hand in hand with multifetal pregnancies. Unfortunately, SART has not done an adequate job of educating the public on the dangers that accompany triplet and quadruplet pregnancies. Even the added risks of twin pregnancies are not insubstantial. Medically, pregnancy with a singleton fetus after two tries at IVF is certainly preferable to a pregnancy with twins or triplets on the first. Yet, as long the SART focus remains as it is, consumers will not appreciate the nuances of its numbers.

(C) Every page of the SART database warns the reader not to compare pregnancy rates among programs because "entry criteria differ." The term entry criteria refer to the specific indications that different programs use to offer IVF treatment to patients with infertility. Many fertility practices, especially in competitive and medically over-served areas like New York City, market themselves to the public specifically as IVF programs. Their goal is to attract patients specifically for the purpose of conceiving through IVF. Of course, there is nothing wrong with this from the patient's view, as long as she is well-informed and ultimately successful. But from a different perspective, if the reason for using IVF is simply that the patient has infertility, then the utilization of IVF in such a program is inappropriately high, and the pregnancy rate artificially inflated. This "fast-track" approach to IVF may make sense in an area where patient financial resources are not an issue, as for many of the clientele in Manhattan-based programs. For most other programs, however, the way IVF is used is quite different and the success rates necessarily differ as well.

Another way in which entry criteria can affect a program's IVF statistics is by being very restrictive. Many of those same programs where the utilization of IVF is very high will also restrict its use mainly to patients with the very highest chances of achieving pregnancy through IVF. This is especially so at programs offering "money-back guarantees." Patients who have failed multiple previous cycles, are older, have evidence of poor ovarian function, or who have other medical reasons to expect failure are generally denied the opportunity to undergo IVF. This keeps the success rates high (while, of course, serving to lure better prognosis patients to the practice, further feeding the cycle of success).

The GENESIS approach to treatment
At GENESIS, we offer IVF to our patients according to standard, well-accepted medical protocols. Many patients who might conceive with IVF at other programs successfully conceive at GENESIS using less aggressive measures. When patients do enter our IVF program, we generally transfer the minimum number of embryos that will give a realistic chance of conception, but with a minimal chance of multifetal pregnancy. We take pride in the fact that our pregnancy rates are high, yet we still have one of the lowest multifetal pregnancy rates in the New York City area, and perhaps in the nation. Finally, at GENESIS we treat patients, not our IVF statistics. Being on the very top statistical rung is not something we chase, because it comes at a cost of being overly selective and closing the door on too many "difficult" patients. We welcome patients who have failed IVF at other programs into ours, so long as they are aware of the risks and benefits of doing so. Happily, many patients who have failed at other programs have succeeded in our hands. These are just some of the elements that prompt us to boast of exceptional outcomes at the GENESIS program.

EXPERIENCE THE DIFFERENCE AT GENESIS
It has been said that, in a medical practice, quality means being able to consistently exceed the patient's expectations. At GENESIS, we take seriously our commitment to providing medical care of exceptional quality. We hope that this introduction to our practice has clearly explained how we measure quality and why the GENESIS program rises above the rest. If you or someone you care about have been trying unsuccessfully to have a baby, let us help. You will be surprised at how easy the road to success can be.
 
1355 84th Street, Brooklyn, NY 11228 808 8th Avenue, Brooklyn, NY 11215
1855 Richmond Avenue, Staten Island, NY 10314 1175 West Broadway, Suite 24, Hewlett, NY 11557
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